Coarctation of the aorta, aortic valvar stenosis, and supravalvar aortic stenosis with left coronary artery ostial stenosis: management using a staged hybrid approach

In this report, we describe a case of coarctation of the aorta, congenital aortic stenosis with bicuspid valve, and supravalvar aortic stenosis with left coronary artery ostial stenosis. The child underwent staged treatment using a hybrid approach employing both surgical and interventional cardiology methods. A single pericardial patch repair technique for supravalvar aortic stenosis associated with left coronary ostial stenosis is also described.

Awareness about biomedical waste management and infection control among dentists of a teaching hospital in New Delhi, India

All 64 dentists working in a teaching hospital of New Delhi participated in a survey. A pre-tested self-administered questionnaire was used to assess knowledge and practices of biomedical waste management and infection control among these dentists. The results show that not all dentists were aware of the risks they were exposed to and only half of them observed infection control practices. In addition to this, majority of them were not aware of proper hospital waste management. The dentists need to be educated on Biomedical Waste (Management & Handling) Rules, 1998 through extensive training programme.

Prevalence of dental disease amongst 5-6 and 12-13 year old school children of Puttur municipality, Karnataka State-India

A survey was conducted among 5-6 and 12-13 years old school children of Puttur municipality, Karnataka State, India, to assess the prevalence of dental caries, malocclusion and dental calculus. A sample size of 200 subjects was taken for each age group and cluster-sampling method was used to select those schools which were to be included in the sample frame. Data collection was done using the Basic Oral Health Survey (WHO) form. The deciduous dentition alone was considered for 5-6 year old subjects while the permanent dentition alone was considered for those aged 12-13 years. A total of 427 subjects from 7 schools were studied. Results indicated that 81.25% of 5-6 year old subjects had dental caries (mean dmft = 4.86 +/- 4.16 S.D.) as compared to 59.6% of 12-13 year old (mean DMFT = 1.87 +/- 2.01 S.D.). The prevalence of malocclusion was 1.79% and 36.95% among those aged 5-6 year and 12-13 year, respectively. None of the 5-6 years old subjects had calculus on their teeth while 47.78% of 12-13 year old subjects exhibited the presence of dental calculus. Overall the prevalence of dental caries was found to be significantly higher among 5-6 year old subjects compared to 12-13 year old subjects. The prevalence of malocclusion and dental calculus was significantly higher among 12-13 year old subjects compared to 5-6 year old subjects.

Use of direct laryngoscope for better exposure in minimally invasive saphenous vein harvesting

A direct laryngoscope-assisted technique of saphenous vein harvesting by tunnelling method is described. This technique provides better exposure through small incisions, thus reducing the chances of trauma to the vein due to excessive handling. The equipment used is inexpensive and readily available.

Iron status, menarche, and calcium supplementation in adolescent girls

The effects of growth, menstrual status, and calcium supplementation on iron status were studied over 4 y in 354 girls in pubertal stage 2 who were premenarcheal at baseline (x+/-SD age: 10.8+/-0.8 y). Girls were randomly assigned to placebo or treatment with 1000 mg Ca/d as calcium citrate malate. Anthropometric characteristics, bone mass, and nutritional status were measured biannually; ferritin was measured annually; and red blood cell indexes were determined at 4 y. The simultaneous effects of iron intake and menstrual status on serum ferritin, after change in lean body mass (LBM) was controlled for, were evaluated in subjects in the upper and lower quartiles of cumulative iron intake. The average maximal accumulation of LBM (386 g/mo; 95% CI: 372, 399) occurred 0.5 y before the onset of menarche. Change in LBM was a significant predictor of serum ferritin (P < 0.0001), with a negative influence on iron status (t ratio=-4.12). The 2 fitted mathematical models representing ferritin concentrations of subjects in the upper and lower quartiles of cumulative iron intake were significantly different (P < 0.018). The regression line of the ferritin concentration in menstruating girls with high iron intakes had a less negative slope than the line fit to serum ferritin concentrations in girls with low iron intakes (NS). Serum ferritin concentrations at 0, 1, 2, 3, and 4 y were not significantly different between groups. In addition, there was no significant difference between groups in any of the red blood cell indexes. In summary, growth spurt and menstrual status had adverse effects on iron stores in adolescent girls with low iron intakes (<9 mg/d), whereas long-term supplementation with calcium (total intake: approximately 1500 mg/d) did not affect iron status.

A novel cell surface proliferation-associated marker expressed on T cells and up-regulated on germinal center B cells

In this study we present data on a novel cell surface antigen recognized by monoclonal antibody (mAb) VPM30, originally thought to recognize only bovine and ovine sIg+ B cells from peripheral blood. Here we show that the antigen, molecular mass 28 kDa, is not only found in B cell follicles in frozen sections, but when used on paraffin sections VPM30 specifically stains B cells in the light zone of germinal centers but not in the mantle or dark zones. In addition we show that the antigen is also expressed by 90% of T cells after activation, with kinetics of antigen expression mirroring those of proliferation. By both size and distribution, the antigen appears to be novel, corresponding to no known cluster of differentiation, and will be of great use in the study of ruminant cellular immune responses.

Knowledge, attitude and practice of dental caries and periodontal disease prevention among primary school teachers in Udupi municipality

Primary school teachers of Udupi municipal corporation were surveyed to determine their knowledge, attitude and practice toward dental caries and periodontal disease prevention. Fourteen schools were selected by cluster sampling and the teachers working in these schools were included in the sample. The questionnaires were completed by one hundred teachers. The results showed that school dental health services must compulsorily hold demonstrations or lectures on prevention of oral diseases during school feasts and parent teacher meetings, in order to involve the teachers and parents in oral health promotion of the child.

Leptin is inversely related to age at menarche in human females

Over the last century there has been a trend toward an earlier onset of menarche attributed to better nutrition and body fatness. With the discovery of the obesity gene and its product, leptin, we reexamined this hypothesis from a new perspective. As delayed menarche and leanness are considered risk factors for osteoporosis, we also evaluated the relation between leptin and bone mass. Body composition and serum leptin levels were measured, and the timing of menarche was recorded in 343 pubertal females over 4 yr. Body composition was measured by dual x-ray absorptiometry, and leptin by a new RIA. All participants were premenarcheal at baseline (aged 8.3-13.1 yr). Leptin was strongly associated with body fat (r = 0.81; P < 0.0001) and change in body fat (r = 0.58; P < 0.0001). The rise in serum leptin concentration up to the level of 12.2 ng/mL (95% confidence interval, 7.2-16.7) was associated with the decline in age at menarche. An increase of 1 ng/mL in serum leptin lowered the age at menarche by 1 month. A serum leptin level of 12.2 ng/mL corresponded to a relative percent body fat of 29.7%, a body mass index of 22.3, and-body fat of 16.0 kg. A gain in body fat of 1 kg lowered the timing of menarche by 13 days. Leptin was positively related to bone area (r = 0.307; P < 0.0001) and change in bone area (r = 0.274; P < 0.0001). A critical blood leptin level is necessary to trigger reproductive ability in women, suggesting a threshold effect. Leptin is a mediator between adipose tissue and the gonads. Leptin may also mediate the effect of obesity on bone mass by influencing the periosteal envelope. This may have implications for the development of osteoporosis and osteoarthritis.

In-hospital results of radiofrequency ablation of supraventricular tachycardia

Two hundred and one consecutive patients with symptomatic paroxysmal supraventricular tachycardia (PSVT) underwent a diagnostic electrophysiological test and catheter ablation with radiofrequency (RF) current. In 102 (51%) patients, the mechanism of PSVT was found to be atrioventricular nodal reentry (AVNRT, typical in 101, atypical in 1). Atrioventricular reentrant tachycardia (AVRT) involving accessory pathway was present in 94 (47%) and ectopic atrial tachycardia in 5 patients. A successful outcome was achieved in 100 of 102 patients (98%) with AVNRT and in 85 of 94 patients (90%) with AVRT. The anatomical approach was used for ablation in patients with AVNRT. The focus was ablated in 4 patients with ectopic atrial tachycardia whereas it was modified in the remaining one patient. Procedure-related complications occurred in 4 patients (2 AVNRT, 2 AVRT). One patient each developed haemothorax, pericardial effusion, mitral valve endocarditis and high-grade AV block requiring permanent pacemaker implantation. The electrode and ablation catheters were repeatedly used after ethylene oxide sterilisation to reduce the cost of the procedure. RF ablation is an effective, safe and curative modality of treatment for patients with symptomatic PSVT due to AVNRT and AVRT. The experience with this modality in patients with ectopic atrial tachycardia is limited.

Comparative study of the efficacy of metoprolol and verapamil in patients with syncope and positive head-up tilt test response

Head-up tilt testing is a reliable diagnostic tool for patients with recurrent unexplained syncope. It has also been used to assess the drug efficacy for the treatment of patients with syncope. The objective of this study was to assess the efficacy of verapamil compared with metoprolol in a randomized crossover design for patients with syncope and a positive tilt test response. Twenty-eight patients with a positive head-up tilt test were randomized to receive either metoprolol or verapamil; the test was repeated after 7 days of therapy. Of the 15 patients initially given metoprolol, 2 (13.3%) did not respond; both were crossed over to verapamil, to which they remained unresponsive. Of the 13 patients who initially received verapamil, 8 (61%) did not respond; after crossing over to metoprolol therapy, 1 remained unresponsive. Overall, 20 of 23 patients receiving metoprolol had negative results on repeat tilt testing, whereas only 5 of 15 patients receiving verapamil had negative results (p < 0.001). In conclusion, the results of this study suggest that verapamil is considerably less efficacious than metoprolol in managing neurocardiogenic syncope.

Low-dose intravenous diltiazem--efficacy and safety in supraventricular tachyarrhythmias

Intravenous diltiazem has been used to rapidly reduce ventricular rate in patients with supraventricular tachyarrhythmias (SVTs). This study assesses the efficacy and safety of a low-dose (0.1 mg/kg) intravenous bolus of diltiazem on the heart rate and blood pressure. Fifteen consecutive patients were treated for 21 episodes of atrial fibrillation, sinus tachycardia or ectopic atrial tachycardia. The bolus dose reduced the heart rate significantly in all patients with atrial fibrillation within 5 min (173 +/- 21 to 144 +/- 27 beats/min, p < 0.05) with the maximum response seen at 10 min (128 +/- 26.7 beats/min, p < 0.05). However, patients with sinus tachycardia showed a significant decrease in heart rate only at 15 min (147 +/- 12 to 123 +/- 15 beats/min, p < 0.05). One patient with ectopic atrial tachycardia required maintenance infusion of diltiazem. Conversion to sinus rhythm was observed in another patient with atrial fibrillation. The drug was well tolerated with no significant hypotension, bradyarrhythmia or aggravation of pre-existing congestive heart failure. It is concluded that Indian patients require a lower dose of intravenous diltiazem as compared to Western ones (0.1 mg/kg versus 0.25-0.33 mg/kg) which gives a prompt, effective and safe response in patients with SVTs.

Pregnancy with epilepsy--a retrospective analysis

OBJECTIVES

To study the course of epilepsy in pregnancy and to assess the perinatal outcome.

METHODS

A retrospective analysis of 219 pregnant patients with epilepsy. The type of epilepsy, drug therapy and seizure frequency were documented. The perinatal outcome of 157 pregnancies with epilepsy was analyzed and compared with that of 471 normal gravidas of similar age and parity.

RESULTS

Generalized seizures occurred in 203 patients, partial seizures in 13 patients and complex partial seizures in three patients. One hundred fifty-two patients (69.41%) were on monotherapy. Carbamazepine was the most common drug (56.58%) used. Ninety-five patients (43.38%) had seizures in the current pregnancy, five of whom had status epilepticus. There was no maternal mortality in status epilepticus. There was no difference in perinatal outcome between the study and control groups. The incidence of congenital malformations was higher in the control group (5/476, 1.05%) than in the study group (1/160, 0.63%). The incidence of low-birth-weight babies was higher in the study group in patients with gestational seizures.

CONCLUSION

The course of pregnancy and perinatal outcome was not altered by epilepsy. There was no increase in the incidence of congenital malformations with the use of monotherapy.

Retail pharmacies in developing countries: a behavior and intervention framework

Retail pharmacies in developing countries are one of the most important sources of advice on pharmaceuticals. Among the reasons the clients give are ease of access; availability of medicines; quality of service (no waiting and convenient hours of operation); and cheaper products, availability of credit, or the option to buy drugs in small amounts. However, the appropriateness of prescribing by retail pharmacy staff has been found to be far from acceptable. In childhood diarrhea, for example, oral rehydration salts (ORS), the appropriate diarrhea treatment, are recommended much less than pharmaceuticals of limited value, such as antimotility agents, adsorbents, etc. Little information is available for reasons underlying such behaviors. In this paper, we present a conceptual framework in which to analyze factors that may affect retail pharmacy prescribing, and we suggest strategies for behavior change. We developed this framework after examining relevant literature on retail pharmacy prescribing. We propose that pharmacy factors, client factors, physician practice and regulatory factors are the four sets of important factors for understanding pharmacy prescribing behavior. For intervention, we present four types of interventions which could be used for changing the behavior of pharmacy staff: information alone, persuasion, incentives and coercion. The behavior and intervention frameworks presented in this paper should also help in guiding further research in this area. For example, new information on the effects of ownership type, availability vs actual role of professional staff and authority structure on pharmacy treatment behaviors would be useful areas for future research. Similarly, additional research is needed on the comparative effects of coercive, persuasive and incentive strategies on pharmacy treatment behaviors.

Radiofrequency ablation of idiopathic ventricular tachycardia

Eleven patients (9 male, 2 female) with ventricular tachycardia (VT) and structurally normal heart underwent radiofrequency (RF) ablation of VT focus. The detailed electrophysiological mapping localized the VT focus in the left ventricular (LV) apicoseptal region in 5, LV posteroseptal region in 2, right ventricular (RV) outflow tract in 2 and RV midseptal and inflow regions in one patient each. The technique of endocardial activation mapping during VT, pacemapping and the presence of His-Purkinje potential (for LV focus) were used to identify the precise site of delivery of RF energy. The procedure was successful in 9 patients. There was no complication. The mean fluoroscopic time was 45 +/- 21 (range 20-120) minutes. RF ablation is effective and may be considered as therapy of choice for patients with ventricular tachycardia and normal heart.

Effects of balloon compliance on angiographic and clinical outcomes after PTCA

Eighty patients underwent percutaneous transluminal coronary angioplasty (PTCA) for 109 lesions. Comparison was done between two groups based on balloon compliance. The groups were comparable in their baseline characteristics. The mean inflation pressure used with compliant balloons was significantly higher; other procedural variables were not different. The occurrence rates of intimal tears and coronary dissections were not significantly different. The rates of side branch occlusions, myocardial infarction, redo PTCA or coronary stenting and death were low and similar, and likewise unaffected by balloon material. We conclude that the occurrence of adverse outcomes after PTCA is unrelated to balloon material compliance.

M-mode echocardiographic diagnosis of left ventricular hypertrophy

To assess the utility of various primary and derived M-Mode Echocardiographic parameters for the purpose of defining left ventricular hypertrophy (LVH), 74 subjects with LVH were subjected to M-mode echocardiographic examination. It was concluded that except for cross sectional area, the other echocardiographic parameters performed too poorly to be of any clinical utility for defining LVH by echocardiography.

Factors that influence peak bone mass formation: a study of calcium balance and the inheritance of bone mass in adolescent females

We suggested that calcium may be an important determinant of peak bone mass. For further elucidation, calcium balances in adolescent females with different calcium intakes (270-1637 mg/d), and a 2-y intervention study of calcium supplementation were performed. Hereditary influences on bone status were also evaluated by comparing subjects' and parents' bone mass. The main determinant of calcium balance was calcium intake; net calcium absorption increased with intake and urinary calcium did not change. Adolescent females retained 200-500 mg Ca/d, suggesting that inadequate calcium intake may translate into inadequate calcium retention and a reduction in peak bone mass. There was a more pronounced increase in bone mass over time in the calcium-supplemented group (1640 mg Ca/d) than in the control group (750 mg Ca/d), but the differences between bone mass measurements were not statistically significant, possibly because of a type II error. By the age of 16 y daughters had accumulated 90-97% of the bone mass of their premenopausal mothers.

Synthesis of substituted 1-hydroxy-2-naphthanilides as potential cestodicidal agents

A series of substituted 1-hydroxy-2-naphthanilides 4--14 has been synthesized by treating 1-hydroxy-2-naphthoic acids 2 with substituted anilines 3. The nitronaphthanilides, on reduction and subsequent treatment with thiophosgene, gave the corresponding substituted 2-naphthanilide isothiocyanates 30--33. Substitution of the chlorine of 8 by various cyclic amines gave 3'-nitro-4'-substituted 1-hydroxy-2-naphthanilides 15--21. Various 3-aryl-4-oxo-2,3-dihydro-1,3-naphthoxazine-2-thiones 34-43 and 3 aryl-2,4-dioxo-2,3-dihydro-1,3-naphthoxazines 44--51 have been prepared by reacting the corresonding naphthanilides with thiophosgene and ethyl chloroformate, respectively. All the compounds were tested for their cestodicidal activity against Hymenolepis nana infection in rats; 30 was found to be the most active compound of the series, showing 100% clearance of infection at a single oral dose of 7.5 mg/kg.